Preterm births affect 15 million babies each year, and are the leading cause of death in children under five worldwide. Global-health researcher Joshua Vogel co-leads a research group aiming to address global challenges in maternal and newborn health, such as how to prevent preterm births (babies born before 37 weeks of gestation) and centre maternal care around women’s experiences. In November 2020, Vogel, who is based at the Burnet Institute in Melbourne, Australia, received the Nature Research Award for Driving Global Impact, which is sponsored by Chinese technology company Tencent. Nature asked for his tips on building a research programme around societal impact.
What are some of the global challenges in maternal and newborn health?
In many parts of the world, pregnant women don’t have access to enough care or education to stay healthy. Our research needs to reflect those realities: often, findings from richer countries with better health care can’t be applied everywhere. For example, our most recent trial addressed a major uncertainty about whether to give steroids to women who are at risk of preterm birth in low-resource countries. Steroids are widely used in pregnancy, but previous trials had been conducted only in high-resource countries. We found a significant reduction in newborn mortality and showed that there was no harm for the mother or newborn, which had been a genuine concern (The WHO ACTION Trials Collaborators N. Engl. J. Med. 383, 2514–2525; 2020). Now we’re updating World Health Organization (WHO) guidelines to translate these findings into practice.
Another challenge is how to make maternity research and care respectful and women-centred globally. There’s been a growing recognition that even when coverage, services and interventions are improved, women do not always have good experiences and are unlikely to return to hospitals for care. How women experience their care is just as important as the care that’s provided.
We’re also not doing enough in terms of pregnancy-specific treatments, which is playing out right now with COVID-19. Of the hundreds of clinical trials that are being done on COVID-related topics, only a few are enrolling pregnant women. There are nearly 140 million births a year globally, so we’re not talking about a small group of people. Some researchers might feel that it’s too hard or complicated to include pregnant women in their studies. But these women are not complicated populations, they’re people who deserve to have an opportunity to participate in research.
What sparked your interest in preterm births?
I have a long-standing interest in global health and addressing big problems in the world. I was looking for something that could marry my passions for research and public health, and was lucky to do my PhD with the maternal and perinatal health team at the WHO in Geneva, Switzerland. During my PhD, I got involved in preterm birth research. It is truly a global issue: it affects about 10% of births in all countries. If we want to do something about reducing deaths in under fives, then we have to do something about preventing or mitigating the effects of preterm births.
What is the focus of your research group?
I finished my PhD in 2015 and am now an associate professor at the Burnet Institute, where I co-lead the Global Women’s and Newborn’s Health Group with my colleague Caroline Homer. In that role, I oversee our team of 23 staff and students in their research projects. We conduct studies and trials to determine how to improve the quality of maternal and perinatal health care, especially in low-resource settings.
I think about new studies and grant opportunities we could target that fit within our overall research scope. Before COVID-19, I spent a couple of months each year travelling to visit our collaborators, who are based in various countries around the world. I would help them to set up trials, recruit participants and conduct site visits at hospitals. Our research is not just about collecting metric data on women’s health outcomes, but also about doing qualitative research to ensure that their perspectives and experiences are captured as information in our studies. We do interviews, focus groups and surveys with women to understand how they perceive their health system and the care they receive.
For example, one of our PhD candidates, Alyce Wilson, is studying how the quality of maternity services can be improved in the East New Britain province of Papua New Guinea. She’s leading a mixed-methods project that uses both qualitative and quantitative research methods to assess women’s experiences of maternity care there. She’s working with clinicians, policymakers and health-service administrators from four facilities where women give birth, to determine how they can improve the quality of maternal care. My role is to support and guide Alyce as she implements her research programme.
How do you base your research programme on societal impact?
Maximizing societal impact is about how you set your research priorities. For example, in 2014, our team at the WHO published a research prioritization exercise, in which we determined the most pressing issues in maternal and perinatal health research for 2015–25 (J. P. Souza et al. Reprod. Health 11, 61; 2014). We did surveys and consultations with international experts. Overwhelmingly, the questions they identified as priorities were based on implementation research: how do we get treatments that we know are effective into practice, and do so cost-effectively? These priorities were distinct from discovery-oriented questions around developing treatments. Effective therapies and medical practices often already exist — it’s all about getting them to the people that need them.
How do collaborations play a part in your research?
Because public-health problems are so complex, you can’t just take a biomedical or biological viewpoint — you also need to think about the health-system lens and sociocultural perspectives. Our team comprises people with backgrounds in medicine, midwifery, public health, pharmacy, international development and social science. We have great collaborations with research groups in Latin America, sub-Saharan Africa and South Asia. Recently, I’ve been working with university-based research groups in India, Kenya, Pakistan, Bangladesh and Nigeria. They’re the ones who best understand the challenges women face in each hospital setting, and they’re the ones on the ground doing the hard work of implementing the studies we develop together.
Any advice for early-career researchers hoping to make their research impactful?
Identify a topic you love and use that as a foundation to develop your experience and credibility. Focusing on preterm birth helped to build my confidence, so now I can branch out into other topics and apply what I learnt. You don’t need to know how to attack everything on day one: your frontier of knowledge and curiosity expands over time. Being part of an environment where you can build networks and connect with people in other disciplines is also really important. Life’s too short to not work with nice people.
What are your plans for the Nature Research Award?
I feel slightly ill at ease with individual accolades because these awards come from teamwork. The funds will be used to support our PhD students, as well as a new 2-year trial with 4 hospitals in India, in which about 50,000 women will give birth. The goal is to improve the quality of labour and childbirth care.